The term “electrical storm”
indicates a life-threatening clinical condition characterized by the recurrence
of hemodynamically unstable ventricular tachycardia and/or ventricular
fibrillation, in particular in patients with ICD implanted for primary or
secondary prevention. Although there isn’t a shared definition of electrical
storm, nowadays the most accepted definition refers to three or more separate
arrhythmia episodes leading to ICD therapies including antitachycardia pacing or shock occurring over a single 24 hours’
time period. Clinical presentation can be dramatic and triggering mechanism are
not clear at all yet, but electrical storm is associated with high mortality
rates and low patients quality of life, both in the acute phase and in the long
term. The first line therapy is based on antiarrhythmic drugs to suppress
electrical storm, but in refractory patients, interventions such as catheter
ablation or in some cases surgical cardiac sympathetic denervation might be
helpful. Anyhow, earlier interventional management can lead to better outcomes than
persisting with antiarrhythmic pharmacologic therapy and, when available, an
early interventional approach should be preferred.